Purpose of review: Biochemical markers are available to detect cardiac involvement in many pediatric disease states and should be considered.
Recent findings: Analyses of three markers are readily available in clinical laboratories for improved diagnosis.
Summary: Increased workload of the heart has been associated with the release of biochemical markers (natriuretic peptides and cardiac enzymes) that indicate that a new genetic program has been activated and maladaptation is occurring in the atria, ventricles, or both. This review summarizes those that have been identified in fetal and pediatric practice. The expression of such markers is traced from early embryonic development to fetal life, to the neonate, to childhood, and then to adult life.